2016-09-07T09:15:21-05:00 2015-12-31 221478099 COHNREZNICK LLP 350 Church Street 12th floor Hartford CT 06103 990 2015-01-01 060863942 COMMUNITY HEALTH SERVICES INC COMM 8602499625 500 ALBANY AVENUE HARTFORD CT 06120 GREGORY L STANTON CEO 8602499625 2016-08-05 1 PAUL BALLASY P00852868 9592007000 2015 2016-12-15 16:53:06Z GREGORY L STANTON 500 ALBANY AVENUE HARTFORD CT 06120 19157422 0 X www.chshartford.org X 1967 CT TO PROVIDE MEDICAL SERVICES FOR THE RESIDENTS OF THE GREATER HARTFORD CONNECTICUT AREA. TO PROVIDE QUALITY HEALTH CARE SERVICES TO LOW AND MODERATE INCOME INDIVIDUALS IN THE GREATER HARTFORD CONNECTICUT AREA REGARDLESS OF ABILITY TO PAY. 15 15 193 80 0 0 5701781 6173497 11939265 12737196 2327 -6249 385443 246121 18028816 19150565 0 0 0 0 12437181 12950430 0 0 0 5856689 5984665 18293870 18935095 -265054 215470 17936788 18135824 1699376 1683764 16237412 16452060 TO PROVIDE MEDICAL SERVICES FOR THE RESIDENTS OF THE GREATER HARTFORD CONNECTICUT AREA. TO PROVIDE QUALITY HEALTH CARE SERVICES TO LOW AND MODERATE INCOME INDIVIDUALS IN THE GREATER HARTFORD CONNECTICUT AREA REGARDLESS OF ABILITY TO PAY. 0 0 14154753 12969692 Provide quality health care services to patients who are low and moderate income individuals in the greater hartford connecticut area. There were 84,248 patient visits in 2015. 14154753 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 1 37 0 1 193 1 0 0 0 0 0 0 0 0 0 0 X 15 15 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 CT X RICHARD NANKEE 8602499625 500 ALBANY AVENUE HARTFORD CT 06120 AIGNER MITCHELL secretary 0.50 X X 0 0 0 Angela Chambers director 0.50 X 0 0 0 CHARLES WILLIAMS DIRECTOR 0.50 X 0 0 0 CLORINDA SOLDEVILA DIRECTOR 0.50 X 0 0 0 FLOYD PAULING director 0.50 X 0 0 0 Heather Woodward Director 0.50 X 0 0 0 JABER ASLANZADEH outgoing VICE CHAIR 1.00 X X 0 0 0 JACQUELINE MCDERMOTT-SELMAN VICE CHAIR 1.00 X X 0 0 0 JOHN SODIPO DIRECTOR 0.50 X 0 0 0 Luis Miguel Ayala Treasurer 1.00 X X 0 0 0 MISHONE DONELSON outgoing CHAIR/director 1.00 X X 0 0 0 Ophni Davis Director 0.50 X 0 0 0 Randy McKenney Director 0.50 X 0 0 0 ROBERT HARRIS Chair 1.00 X X 0 0 0 ROSEMARY TATE DIRECTOR 0.50 X 0 0 0 SHERWOOD LEWIS director 0.50 X 0 0 0 tawanda dillard outgoing director 0.50 X 0 0 0 Yvonne Addo director 0.50 X 0 0 0 GREGORY STANTON CHIEF EXECUTIVE OFFICER 40.00 X 197738 0 13548 Richard Nankee CHIEF FINANCIAL OFFICER 10/15 40.00 X 20739 0 3420 SCOTT BRABANT CHIEF FINANCIAL OFFICER thru 6/15 40.00 X 92454 0 13814 ZEEV HAREL Director of Adolescent and Pediatric 40.00 X 230853 0 26685 Cynthia Elis director of women's health 40.00 X 149063 0 33361 Dhivya Kannabiran OB/GYN 40.00 X 155889 0 21671 Elizabeth Reynolds Physician 40.00 X 164446 0 8427 Jairo Montezuma Director of Adult Medicine 40.00 X 154720 0 20156 Wilner Samson CMO 40.00 X 189238 0 27470 1355140 0 168552 13 0 1 0 QUALITY SYSTEMS INC PO BOX 809390 CHICAGO IL 60680 SOFTWARE INSTALLATION & IMPLEMENTATION 169046 Denture Center 41 Fleetwood Road Newington CT 06111 Lab for Dentures 127106 DIVERSIFIED BUILDERS 340 QUINNIPIAC STREET WALLINGFORD CT 06492 CONSTRUCTION MANAGEMENT 111029 GURRENDER SAHANI 43 West Hills Drive Avon CT 06001 PSYCHIATRIST 102000 4 6065229 108268 626187 6173497 Medicaid 621400 8966824 8966824 Medicare 621400 1698744 1698744 Third-party payors 621400 969315 969315 pharmacy revenue 621400 935691 935691 Patients 621400 166622 166622 12737196 608 608 13625 0 13625 13625 13625 6857 -6857 -6857 -6857 meaningful use 900099 212500 212500 Other revenue 900099 19996 19996 232496 19150565 12969692 0 7376 601987 421391 180596 9579304 6705510 2873794 225433 157803 67630 1742822 1219974 522848 800884 560618 240266 57095 480 56615 41601 41601 856130 724368 131762 121289 84902 36387 407440 318854 88586 4441 2220 2221 80281 40140 40141 37856 26499 11357 1063594 776424 287170 148713 108560 40153 PROVISION FOR BAD DEBTS 1212691 1212691 program activities 748261 748261 vaccines 626187 626187 equipment rental 479305 349893 129412 99781 69978 29803 18935095 14154753 4780342 0 929476 1691877 1123149 1123595 283702 474053 659807 693594 208316 398628 159762 137363 22192609 8599088 14548560 13593521 13883 13060 10133 10133 17936788 18135824 836508 975604 862868 708160 1699376 1683764 X 16195984 16408601 41428 43459 16237412 16452060 17936788 18135824 215470 -822 0 X X 0 1 X 1 1 1 X 8776058 6050041 5810745 5701781 6173497 32512122 8776058 6050041 5810745 5701781 6173497 32512122 32512122 774 48787 44649 46667 14233 155110 66616 408513 27657 339303 232496 1074585 33741817 55859072 0.96360 0.96920 X Schedule A, Part II, Line 10, Explanation of Other Income: OTHER INCOME - 2011 Amount: $ 48,166. 2012 Amount: $ 26,013. 2013 Amount: $ 27,657. 2014 Amount: $ 20,553. 2015 Amount: $ 19,996. fundraising income - 2011 Amount: $ 18,450. Meaningful Use - 2012 Amount: $ 382,500. 2014 Amount: $ 318,750. 2015 Amount: $ 212,500. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 133022 133022 18330096 6511937 11818159 3673038 2056798 1616240 56453 30353 26100 13593521 X 17937052 -822 -1212691 -1213513 19150565 0 19150565 17722404 0 17722404 1212691 1212691 18935095 Part X, Line 2: The Center has no unrecognized tax benefits at December 31, 2015 and 2014. The Center's Federal and state information returns prior to calendar year 2012 are closed and management continually evaluates expiring statutes of limitations, audits, proposed settlements, changes in tax law and new authoritative rulings. If the Center has unrelated business income taxes, it will recognize interest and penalties associated with uncertain tax positions as part of the income tax provision and include accrued interest and penalties with the related tax liability in the statement of financial position. Part XI, Line 2d - Other Adjustments: provision for bad debts -1,212,691. Part XII, Line 4b - Other Adjustments: Provision for bad debts 1,212,691. X X X 0 0 0 0 0 0 0 1 0 GREGORY STANTON CHIEF EXECUTIVE OFFICER 197738 0 0 0 0 0 6112 0 8462 0 212312 0 0 0 ZEEV HAREL Director of Adolescent and Pediatric 209953 0 20900 0 0 0 7950 0 19761 0 258564 0 0 0 Cynthia Elis director of women's health 141777 0 0 0 7286 0 6013 0 28289 0 183365 0 0 0 Dhivya Kannabiran OB/GYN 155889 0 0 0 0 0 831 0 21866 0 178586 0 0 0 Elizabeth Reynolds Physician 164446 0 0 0 0 0 0 0 9453 0 173899 0 0 0 Jairo Montezuma Director of Adult Medicine 154720 0 0 0 0 0 0 0 21182 0 175902 0 0 0 Wilner Samson CMO 189238 0 0 0 0 0 7727 0 20598 0 217563 0 0 0 Part I, Line 7 zeev harel received a calendar year 2015 board approved bonus in the amount of $20,900. X 1 626187 FAIR MARKET VALUE 0 0 0 Part I, Column (b): Column B Represents number of contributors. Form 990, Part VI, Section B, line 11 the finance department along with the ceo reviews the form 990 and it is then forwarded to the finance committee for their review. The 990 is then distributed to the full board for approval. Form 990, Part VI, Section B, line 12c community health services, Inc. requires that all employees and board members sign a written conflict of interest policy. this conflict of interest policy is monitored and enforced by the corporate compliance officer and the corporate compliance team which meets on a quarterly basis. Form 990, Part VI, Section B, line 15 the board of directors, in an executive meeting, determines the compensation of the ceo. they use a local nonprofit ceo compensation survey as a guideline. the ceo determines the compensation of the organization's employees. he is guided by state and national guidelines and surveys as well as a survey done yearly for the community health centers in connecticut by the community health center association of connecticut. Form 990, Part VI, Section C, line 19 community health services' governing documents, conflict of interest policy and financial statements are available upon request. FORM 990, PART XII, LINE 2C THERE HAVE BEEN NO CHANGES MADE TO THE ORGANIZATION'S OVERSIGHT OR SELECTION PROCESS DURING THE TAX YEAR.